Nursing home · SNF / NF

A Grace Sub Acute & Skilled Care

Federal · CMS State licenseActive CMS certificationCCN 056376CA lic. 070000051For profit CMS overall

1250 S. Winchester Boulevard, San Jose, CA 95128 · Operated by Lita & Ava Inc

Source: CMS Provider Data Catalog, release Oct 16, 2026 + state license · provenance

$25 Full Intelligence Report

Certified beds

166

Avg residents / day

126

Inspections

Citations

Harm-level

Fines

State actions

Facility type: Nursing home · SNF / NF
CMS provider type: Medicare and Medicaid
Certified beds: 166 CMS-certified beds (not state-licensed beds)
Licensed beds: 166 state-licensed beds · California Department of Public Health
State license: 070000051 active · licensee CELEBES SEA HOLDINGS LLC
Average residents per day: 125.8 CMS, MDS-derived
CMS Certification Number: 056376
Certification status: Active CMS certification Verified
First approved (Medicare/Medicaid): Jul 1, 1980
Ownership type: For profit - Corporation
Operator (legal business name): Lita & Ava Inc
CMS chain: Not part of a CMS-reported chain
Phone: (408) 241-3844
Resident & family council: Resident
Sprinklers in all required areas: Yes
Official profile: Medicare Care Compare ↗

State enforcement · CA (historical)

Historical

State actions

2000–2022

Class AA / A

no class AA

Since 2019

$80k final penalties

California CDPH state citations and administrative penalties, 1997 to early 2024 (archived dataset). Separate from federal CMS deficiencies.

Inspection record · CMS window

Verified

Inspections

latest Dec 10, 2025

Citations

47 health · 33 fire

Harm or worse

no immediate jeopardy

Severity	Isolated	Pattern	Widespread
Immediate jeopardy	J·	K·	L·
Actual harm	G·	H·	I·
Potential harm	D53	E19	F3
Minimal	A·	B·	C5

CMS publishes about the three most recent standard surveys plus complaint and infection-control inspections from the prior three years. Older findings leave the dataset; their absence is not evidence they never happened.

CMS Five-Star ratings

Federal · CMS

Overall

Health inspections

Staffing

Quality measures

Penalties · about the last 3 years

Fines

Payment denials

Latest

—

Date	Domain	Survey types	Citations	Most severe	Open
Dec 10, 2025	Fire safety	Fire Safety Complaint	2	Potential harm	—	Open →
Aug 14, 2025	Health	Health Complaint	1	Potential harm	—	Open →
Oct 18, 2024	Fire safety	Fire Safety Standard	9	Potential harm	—	Open →
Oct 18, 2024	Health	Health Standard	13	Potential harm	—	Open →
Jul 9, 2024	Health	Health Complaint	1	Potential harm	—	Open →
Mar 14, 2024	Health	Health Complaint	1	Potential harm	—	Open →
Dec 28, 2023	Health	Health Complaint	1	Potential harm	—	Open →
May 13, 2022	Fire safety	Fire Safety Standard	10	Potential harm	—	Open →
May 13, 2022	Health	Health Standard	15	Potential harm	—	Open →
Jun 7, 2019	Fire safety	Fire Safety Standard	12	Potential harm	—	Open →
Jun 7, 2019	Health	Health Standard	15	Potential harm	—	Open →

Enforcement

Penalties

Civil money penalties and denials of payment for new admissions, as published by CMS (about the last three years). Amounts may change on appeal.

No fines or payment denials in the CMS Penalties file for this CCN.

State citations & penalties · historical

State enforcement · California

California CDPH state citations and administrative penalties, 1997 to early 2024 (archived dataset). Separate from federal CMS deficiencies.

Issued	Class	Type	Category	Final amount	Flags	Record
Feb 10, 2022 violation Jun 16, 2020	Class A	Citation Citation A (HSC 1424)	Patient Care	$20,000	Appealed Closed	070016089
Nov 10, 2020 violation Mar 31, 2019	AP NHPPD	Administrative Penalty AP - 3.2 Nursing-Hours-per-Patient-Day AP (HSC 1276.5)	DHPPD: 2 - 11 Days	$15,000	Closed	810016128
Jul 31, 2018 violation Jun 18, 2018	Class B	Citation Citation B (HSC 1424)	Medication	$2,000	Closed	070014299
Jan 30, 2012 violation Jan 7, 2012	Class B	Citation Citation B (HSC 1424)	Patient Care	$750	Closed	070008956
Aug 30, 2011 violation Aug 22, 2011	Class B	Citation Citation B (HSC 1424)	Medication	$700	Appealed Closed	070008517
Oct 27, 2010 violation Oct 12, 2010	Class B	Citation Citation B (HSC 1424)	Patient Rights	$800	Appealed Closed	070007677
Jul 23, 2010 violation Jan 13, 2010	Class B	Citation Citation B (HSC 1424)	Patient Care	$750	Appealed Closed	070007402
Jun 30, 2010 violation May 25, 2010	Class A	Citation Citation A (HSC 1424)	Patient Care	$13,500 initial $20,000	Appealed Closed	070007348
May 25, 2010 violation May 17, 2010	Class B	Citation Citation B (HSC 1424)	Medication	$800	Appealed Closed	070007236
Feb 17, 2010 violation Sep 3, 2009	Class B	Citation Citation B (HSC 1424)	Administration	$400 initial $800	Appealed Closed	070006741
Feb 16, 2010 violation Sep 15, 2009	Class B	Citation Citation B (HSC 1424)	Patient Rights	$0 initial $850	Appealed Closed	070006997
Sep 16, 2009 violation Aug 24, 2009	Class B	Citation Citation B (HSC 1424)	Medication	$0 initial $900	Appealed Closed	070006507
Aug 25, 2009 violation Jul 19, 2009	Class B	Citation Citation B (HSC 1424)	Patient Rights	$0 initial $850	Appealed Closed	070006493
Aug 25, 2009 violation Jul 18, 2009	Class B	Citation Citation B (HSC 1424)	Patient Care	$0 initial $850	Appealed Closed	070006492
Jul 27, 2009 violation Jun 28, 2009	Class B	Citation Citation B (HSC 1424)	Patient Care	$0 initial $900	Appealed Closed	070006419
Jun 29, 2009 violation May 10, 2009	Class B	Citation Citation B (HSC 1424)	Patient Care	$950	Closed	070006329
Jun 26, 2009 violation Sep 24, 2008	Class B	Citation Citation B (HSC 1424)	Patient Rights	$0 initial $700	Death relatedAppealed Closed	070006328
Apr 27, 2009 violation Apr 21, 2009	Class B	Citation Citation B (HSC 1424)	Patient Care	$1,000	Closed	070006122
Apr 24, 2009 violation Apr 5, 2009	Class B	Citation Citation B (HSC 1424)	Patient Care	$900	Closed	070006074
Apr 24, 2009 violation Apr 5, 2009	Class B	Citation Citation B (HSC 1424)	Patient Care	$600	Closed	070006073
Jan 27, 2009 violation Jan 7, 2009	Class B	Citation Citation B (HSC 1424)	Patient Rights	$1,000	Appealed Closed	070005825
Sep 26, 2008 violation Sep 4, 2008	Class B	Citation Citation B (HSC 1424)	Patient Care	$700	Closed	070005422
Jan 31, 2008 violation Jan 17, 2008	Class B	Citation Citation B (HSC 1424)	Patient Care	$950	Closed	070004640
Nov 8, 2007 violation Aug 7, 2007	Class B	Citation Citation B (HSC 1424)	Patient Care	$750	Appealed Closed	070004438
Nov 8, 2007 violation Mar 2, 2007	Class B	Citation Citation B (HSC 1424)	Patient Care	$650	Appealed Closed	070004291
Sep 6, 2007 violation Jul 1, 2007	Class A	Citation Citation A (HSC 1424)	Patient Care	$15,000	Closed	070004183
Aug 16, 2007 violation Jun 19, 2007	Class B	Citation Citation B (HSC 1424)	Patient Care	$600	Appealed Closed	070004106
Aug 16, 2007 violation Jun 24, 2007	Class B	Citation Citation B (HSC 1424)	Patient Rights	$750	Appealed Closed	070004088
Sep 14, 2005 violation Jul 21, 2005	Class B	Citation Citation B (HSC 1424)	Administration	$700	Appealed Closed	070002607
Jan 14, 2000 violation Dec 16, 1999	Class B	Citation Citation B (HSC 1424)	Patient Rights	$1,000	Closed	070002312

Scope × severity

Severity	Isolated	Pattern	Widespread
Immediate jeopardy	J·	K·	L·
Actual harm	G·	H·	I·
Potential harm	D53	E19	F3
Minimal	A·	B·	C5

By concept

Date	Tag	Deficiency	Scope / severity	Correction	Flags
Dec 10, 2025	K-0712	Have simulated fire drills held at unexpected times. Miscellaneous Deficiencies · Environment & life safety	F · Potential harm Widespread	Corrected Dec 24, 2025	Complaint
Dec 10, 2025	K-0920	Ensure proper usage of power strips and extension cords. Gas, Vacuum, and Electrical Systems Deficiencies · Environment & life safety	F · Potential harm Widespread	Corrected Dec 24, 2025	Complaint
Aug 14, 2025	F-0755	Provide pharmaceutical services to meet the needs of each resident and employ or obtain the services of a licensed pharmacist. Pharmacy Service Deficiencies · Medication management	D · Potential harm Isolated	Corrected Sep 4, 2025	Complaint
Oct 18, 2024	K-0161	Use approved construction type or materials. Construction Deficiencies · Environment & life safety	D · Potential harm Isolated	Corrected Oct 30, 2024
Oct 18, 2024	K-0351	Install an approved automatic sprinkler system. Smoke Deficiencies · Environment & life safety	E · Potential harm Pattern	Corrected Oct 30, 2024
Oct 18, 2024	K-0353	Inspect, test, and maintain automatic sprinkler systems. Smoke Deficiencies · Environment & life safety	D · Potential harm Isolated	Corrected Oct 30, 2024
Oct 18, 2024	K-0363	Install corridor and hallway doors that block smoke. Smoke Deficiencies · Environment & life safety	D · Potential harm Isolated	Corrected Oct 30, 2024
Oct 18, 2024	K-0500	Meet other general requirements that are deficient. Services Deficiencies · Environment & life safety	D · Potential harm Isolated	Corrected Oct 30, 2024
Oct 18, 2024	K-0511	Have properly installed electrical wiring and gas equipment. Services Deficiencies · Environment & life safety	D · Potential harm Isolated	Corrected Oct 30, 2024
Oct 18, 2024	K-0711	Provide a written emergency evacuation plan. Miscellaneous Deficiencies · Environment & life safety	D · Potential harm Isolated	Corrected Oct 30, 2024
Oct 18, 2024	K-0712	Have simulated fire drills held at unexpected times. Miscellaneous Deficiencies · Environment & life safety	F · Potential harm Widespread	Corrected Oct 30, 2024
Oct 18, 2024	K-0920	Ensure proper usage of power strips and extension cords. Gas, Vacuum, and Electrical Systems Deficiencies · Environment & life safety	D · Potential harm Isolated	Corrected Oct 30, 2024
Oct 18, 2024	F-0558	Reasonably accommodate the needs and preferences of each resident. Resident Rights Deficiencies · Resident rights & abuse/neglect	D · Potential harm Isolated	Corrected Nov 8, 2024
Oct 18, 2024	F-0655	Create and put into place a plan for meeting the resident's most immediate needs within 48 hours of being admitted Resident Assessment and Care Planning Deficiencies · Clinical care	D · Potential harm Isolated	Corrected Nov 8, 2024
Oct 18, 2024	F-0658	Ensure services provided by the nursing facility meet professional standards of quality. Resident Assessment and Care Planning Deficiencies · Clinical care	E · Potential harm Pattern	Corrected Nov 8, 2024
Oct 18, 2024	F-0700	Try different approaches before using a bed rail. If a bed rail is needed, the facility must (1) assess a resident for safety risk; (2) review these risks and benefits with the resident/representative; (3) get informed consent; and (4) Correctly install and maintain the bed rail. Quality of Life and Care Deficiencies · Clinical care	E · Potential harm Pattern	Corrected Nov 8, 2024
Oct 18, 2024	F-0755	Provide pharmaceutical services to meet the needs of each resident and employ or obtain the services of a licensed pharmacist. Pharmacy Service Deficiencies · Medication management	E · Potential harm Pattern	Corrected Nov 8, 2024
Oct 18, 2024	F-0756	Ensure a licensed pharmacist perform a monthly drug regimen review, including the medical chart, following irregularity reporting guidelines in developed policies and procedures. Pharmacy Service Deficiencies · Medication management	D · Potential harm Isolated	Corrected Nov 8, 2024
Oct 18, 2024	F-0757	Ensure each resident’s drug regimen must be free from unnecessary drugs. Pharmacy Service Deficiencies · Medication management	D · Potential harm Isolated	Corrected Nov 8, 2024
Oct 18, 2024	F-0759	Ensure medication error rates are not 5 percent or greater. Pharmacy Service Deficiencies · Medication management	D · Potential harm Isolated	Corrected Nov 8, 2024
Oct 18, 2024	F-0806	Ensure each resident receives and the facility provides food that accommodates resident allergies, intolerances, and preferences, as well as appealing options. Nutrition and Dietary Deficiencies · Food, nutrition & hydration	D · Potential harm Isolated	Corrected Nov 8, 2024
Oct 18, 2024	F-0812	Procure food from sources approved or considered satisfactory and store, prepare, distribute and serve food in accordance with professional standards. Nutrition and Dietary Deficiencies · Food, nutrition & hydration	E · Potential harm Pattern	Corrected Nov 8, 2024
Oct 18, 2024	F-0880	Provide and implement an infection prevention and control program. Infection Control Deficiencies · Infection prevention	E · Potential harm Pattern	Corrected Nov 8, 2024
Oct 18, 2024	F-0919	Make sure that a working call system is available in each resident's bathroom and bathing area. Environmental Deficiencies · Environment & life safety	D · Potential harm Isolated	Corrected Nov 8, 2024
Oct 18, 2024	F-0921	Make sure that the nursing home area is safe, easy to use, clean and comfortable for residents, staff and the public. Environmental Deficiencies · Environment & life safety	D · Potential harm Isolated	Corrected Nov 8, 2024
Jul 9, 2024	F-0684	Provide appropriate treatment and care according to orders, resident’s preferences and goals. Quality of Life and Care Deficiencies · Clinical care	D · Potential harm Isolated	Corrected Jul 10, 2024	Complaint
Mar 14, 2024	F-0689	Ensure that a nursing home area is free from accident hazards and provides adequate supervision to prevent accidents. Quality of Life and Care Deficiencies · Clinical care	D · Potential harm Isolated	Corrected Apr 11, 2024	Complaint
Dec 28, 2023	F-0684	Provide appropriate treatment and care according to orders, resident’s preferences and goals. Quality of Life and Care Deficiencies · Clinical care	D · Potential harm Isolated	Corrected Jan 29, 2024	Complaint
May 13, 2022	K-0161	Use approved construction type or materials. Construction Deficiencies · Environment & life safety	E · Potential harm Pattern	Corrected Jun 6, 2022
May 13, 2022	K-0293	Have properly located and lighted "Exit" signs. Egress Deficiencies · Environment & life safety	D · Potential harm Isolated	Corrected Jun 6, 2022
May 13, 2022	K-0321	Ensure that special areas are constructed so that walls can resist fire for one hour or have an approved fire extinguishing system. Smoke Deficiencies · Environment & life safety	E · Potential harm Pattern	Corrected Jun 6, 2022
May 13, 2022	K-0353	Inspect, test, and maintain automatic sprinkler systems. Smoke Deficiencies · Environment & life safety	D · Potential harm Isolated	Corrected Jun 6, 2022
May 13, 2022	K-0355	Properly select, install, inspect, or maintain portable fire extinguishes. Smoke Deficiencies · Environment & life safety	E · Potential harm Pattern	Corrected Jun 6, 2022
May 13, 2022	K-0363	Install corridor and hallway doors that block smoke. Smoke Deficiencies · Environment & life safety	E · Potential harm Pattern	Corrected Jun 6, 2022
May 13, 2022	K-0511	Have properly installed electrical wiring and gas equipment. Services Deficiencies · Environment & life safety	E · Potential harm Pattern	Corrected Jun 6, 2022
May 13, 2022	K-0741	Have posted "No-smoking" signs in areas where smoking is not permitted or ashtrays provided where smoking was allowed. Miscellaneous Deficiencies · Environment & life safety	D · Potential harm Isolated	Corrected Jun 6, 2022
May 13, 2022	K-0920	Ensure proper usage of power strips and extension cords. Gas, Vacuum, and Electrical Systems Deficiencies · Environment & life safety	D · Potential harm Isolated	Corrected Jun 6, 2022
May 13, 2022	K-0923	Have proper medical gas storage and administration areas. Gas, Vacuum, and Electrical Systems Deficiencies · Environment & life safety	D · Potential harm Isolated	Corrected Jun 6, 2022
May 13, 2022	F-0552	Ensure that residents are fully informed and understand their health status, care and treatments. Resident Rights Deficiencies · Resident rights & abuse/neglect	D · Potential harm Isolated	Corrected May 16, 2022
May 13, 2022	F-0558	Reasonably accommodate the needs and preferences of each resident. Resident Rights Deficiencies · Resident rights & abuse/neglect	D · Potential harm Isolated	Corrected May 25, 2022
May 13, 2022	F-0583	Keep residents' personal and medical records private and confidential. Resident Rights Deficiencies · Resident rights & abuse/neglect	D · Potential harm Isolated	Corrected May 25, 2022
May 13, 2022	F-0658	Ensure services provided by the nursing facility meet professional standards of quality. Resident Assessment and Care Planning Deficiencies · Clinical care	E · Potential harm Pattern	Corrected May 25, 2022
May 13, 2022	F-0688	Provide appropriate care for a resident to maintain and/or improve range of motion (ROM), limited ROM and/or mobility, unless a decline is for a medical reason. Quality of Life and Care Deficiencies · Clinical care	D · Potential harm Isolated	Corrected May 27, 2022
May 13, 2022	F-0697	Provide safe, appropriate pain management for a resident who requires such services. Quality of Life and Care Deficiencies · Clinical care	D · Potential harm Isolated	Corrected May 25, 2022
May 13, 2022	F-0698	Provide safe, appropriate dialysis care/services for a resident who requires such services. Quality of Life and Care Deficiencies · Clinical care	D · Potential harm Isolated	Corrected May 25, 2022
May 13, 2022	F-0755	Provide pharmaceutical services to meet the needs of each resident and employ or obtain the services of a licensed pharmacist. Pharmacy Service Deficiencies · Medication management	E · Potential harm Pattern	Corrected May 27, 2022
May 13, 2022	F-0756	Ensure a licensed pharmacist perform a monthly drug regimen review, including the medical chart, following irregularity reporting guidelines in developed policies and procedures. Pharmacy Service Deficiencies · Medication management	D · Potential harm Isolated	Corrected May 13, 2022
May 13, 2022	F-0758	Implement gradual dose reductions(GDR) and non-pharmacological interventions, unless contraindicated, prior to initiating or instead of continuing psychotropic medication; and PRN orders for psychotropic medications are only used when the medication is necessary and PRN use is limited. Pharmacy Service Deficiencies · Medication management	D · Potential harm Isolated	Corrected May 13, 2022
May 13, 2022	F-0759	Ensure medication error rates are not 5 percent or greater. Pharmacy Service Deficiencies · Medication management	E · Potential harm Pattern	Corrected May 27, 2022
May 13, 2022	F-0761	Ensure drugs and biologicals used in the facility are labeled in accordance with currently accepted professional principles; and all drugs and biologicals must be stored in locked compartments, separately locked, compartments for controlled drugs. Pharmacy Service Deficiencies · Medication management	D · Potential harm Isolated	Corrected May 13, 2022
May 13, 2022	F-0790	Provide routine and 24-hour emergency dental care for each resident. Quality of Life and Care Deficiencies · Clinical care	D · Potential harm Isolated	Corrected May 27, 2022
May 13, 2022	F-0812	Procure food from sources approved or considered satisfactory and store, prepare, distribute and serve food in accordance with professional standards. Nutrition and Dietary Deficiencies · Food, nutrition & hydration	E · Potential harm Pattern	Corrected May 26, 2022
May 13, 2022	F-0880	Provide and implement an infection prevention and control program. Infection Control Deficiencies · Infection prevention	E · Potential harm Pattern	Corrected Jun 3, 2022
Jun 7, 2019	K-0291	Install emergency lighting that can last at least 1 1/2 hours. Egress Deficiencies · Environment & life safety	D · Potential harm Isolated	Corrected Aug 29, 2019
Jun 7, 2019	K-0293	Have properly located and lighted "Exit" signs. Egress Deficiencies · Environment & life safety	E · Potential harm Pattern	Corrected Aug 29, 2019
Jun 7, 2019	K-0347	Properly provide smoke detection systems in areas open to corridors. Smoke Deficiencies · Environment & life safety	D · Potential harm Isolated	Corrected Aug 29, 2019
Jun 7, 2019	K-0353	Inspect, test, and maintain automatic sprinkler systems. Smoke Deficiencies · Environment & life safety	D · Potential harm Isolated	Corrected Aug 29, 2019
Jun 7, 2019	K-0363	Install corridor and hallway doors that block smoke. Smoke Deficiencies · Environment & life safety	E · Potential harm Pattern	Corrected Aug 29, 2019
Jun 7, 2019	K-0511	Have properly installed electrical wiring and gas equipment. Services Deficiencies · Environment & life safety	D · Potential harm Isolated	Corrected Aug 29, 2019
Jun 7, 2019	K-0920	Ensure proper usage of power strips and extension cords. Gas, Vacuum, and Electrical Systems Deficiencies · Environment & life safety	D · Potential harm Isolated	Corrected Aug 29, 2019
Jun 7, 2019	F-0550	Honor the resident's right to a dignified existence, self-determination, communication, and to exercise his or her rights. Resident Rights Deficiencies · Resident rights & abuse/neglect	D · Potential harm Isolated	Corrected Jun 26, 2019
Jun 7, 2019	F-0552	Ensure that residents are fully informed and understand their health status, care and treatments. Resident Rights Deficiencies · Resident rights & abuse/neglect	D · Potential harm Isolated	Corrected Jun 26, 2019
Jun 7, 2019	F-0609	Timely report suspected abuse, neglect, or theft and report the results of the investigation to proper authorities. Freedom from Abuse, Neglect, and Exploitation Deficiencies · Resident rights & abuse/neglect	D · Potential harm Isolated	Corrected Jun 26, 2019
Jun 7, 2019	F-0623	Provide timely notification to the resident, and if applicable to the resident representative and ombudsman, before transfer or discharge, including appeal rights. Resident Rights Deficiencies · Resident rights & abuse/neglect	D · Potential harm Isolated	Corrected Jun 26, 2019
Jun 7, 2019	F-0641	Ensure each resident receives an accurate assessment. Resident Assessment and Care Planning Deficiencies · Clinical care	D · Potential harm Isolated	Corrected Jun 26, 2019
Jun 7, 2019	F-0656	Develop and implement a complete care plan that meets all the resident's needs, with timetables and actions that can be measured. Resident Assessment and Care Planning Deficiencies · Clinical care	D · Potential harm Isolated	Corrected Jun 26, 2019
Jun 7, 2019	F-0688	Provide appropriate care for a resident to maintain and/or improve range of motion (ROM), limited ROM and/or mobility, unless a decline is for a medical reason. Quality of Life and Care Deficiencies · Clinical care	D · Potential harm Isolated	Corrected Jun 26, 2019
Jun 7, 2019	F-0693	Ensure that feeding tubes are not used unless there is a medical reason and the resident agrees; and provide appropriate care for a resident with a feeding tube. Quality of Life and Care Deficiencies · Clinical care	D · Potential harm Isolated	Corrected Jun 26, 2019
Jun 7, 2019	F-0740	Ensure each resident must receive and the facility must provide necessary behavioral health care and services. Quality of Life and Care Deficiencies · Clinical care	D · Potential harm Isolated	Corrected Jun 26, 2019
Jun 7, 2019	F-0755	Provide pharmaceutical services to meet the needs of each resident and employ or obtain the services of a licensed pharmacist. Pharmacy Service Deficiencies · Medication management	D · Potential harm Isolated	Corrected Jun 26, 2019
Jun 7, 2019	F-0758	Implement gradual dose reductions(GDR) and non-pharmacological interventions, unless contraindicated, prior to initiating or instead of continuing psychotropic medication; and PRN orders for psychotropic medications are only used when the medication is necessary and PRN use is limited. Pharmacy Service Deficiencies · Medication management	D · Potential harm Isolated	Corrected Jun 26, 2019
Jun 7, 2019	F-0759	Ensure medication error rates are not 5 percent or greater. Pharmacy Service Deficiencies · Medication management	D · Potential harm Isolated	Corrected Jun 26, 2019
Jun 7, 2019	F-0761	Ensure drugs and biologicals used in the facility are labeled in accordance with currently accepted professional principles; and all drugs and biologicals must be stored in locked compartments, separately locked, compartments for controlled drugs. Pharmacy Service Deficiencies · Medication management	D · Potential harm Isolated	Corrected Jun 26, 2019
Jun 7, 2019	F-0813	Have a policy regarding use and storage of foods brought to residents by family and other visitors. Nutrition and Dietary Deficiencies · Food, nutrition & hydration	D · Potential harm Isolated	Corrected Jun 26, 2019
Jun 7, 2019	F-0880	Provide and implement an infection prevention and control program. Infection Control Deficiencies · Infection prevention	E · Potential harm Pattern	Corrected Jun 26, 2019
Jun 7, 2019	E-0015	Address subsistence needs for staff and patients. Emergency Preparedness Deficiencies · Emergency preparedness	C · Minimal Widespread	Corrected Aug 29, 2019
Jun 7, 2019	E-0024	Establish policies and procedures for volunteers. Emergency Preparedness Deficiencies · Emergency preparedness	C · Minimal Widespread	Corrected Aug 29, 2019
Jun 7, 2019	E-0026	Establish roles under a Waiver declared by secretary. Emergency Preparedness Deficiencies · Emergency preparedness	C · Minimal Widespread	Corrected Aug 29, 2019
Jun 7, 2019	E-0033	Establish methods for sharing information. Emergency Preparedness Deficiencies · Emergency preparedness	C · Minimal Widespread	Corrected Aug 29, 2019
Jun 7, 2019	E-0034	Provide a means of sharing information on occupancy/needs. Emergency Preparedness Deficiencies · Emergency preparedness	C · Minimal Widespread	Corrected Aug 29, 2019

“Corrected” does not erase a citation: the historical finding stays listed with its disposition. Narrative statements of deficiencies are not part of the CMS dataset; see Care Compare for the official inspection report.

Operating entity

Lita & Ava Inc

CMS legal business name of the certified provider. Operates this facility only.

VerifiedLinked by exact legal name

CMS chain

Not part of a CMS-reported chain.

Ownership disclosures

Disclosures

Organizations

Individuals

Direct & indirect ownership

Owners of record

Name	Type	Role (Carefield group)	CMS role text	Share	Since
Jason Adelman	Individual	Direct owner	5% OR GREATER DIRECT OWNERSHIP INTEREST	not provided	Dec 15, 2008
Julita Javier	Individual	Direct owner	5% OR GREATER DIRECT OWNERSHIP INTEREST	not provided	Dec 15, 2008
Pepito Javier	Individual	Direct owner	5% OR GREATER DIRECT OWNERSHIP INTEREST	not provided	Dec 15, 2008
James Rando	Individual	Direct owner	5% OR GREATER DIRECT OWNERSHIP INTEREST	not provided	Dec 15, 2008

CMS Ownership file

All disclosed roles

Operator, owners, managers, officers and lenders are distinct roles and are never flattened into one entity. Organizations link across facilities by exact normalized legal name; individuals are listed per facility only.

Name	Type	Role (Carefield group)	CMS role text	Share	Since
Jason Adelman	Individual	Direct owner	5% OR GREATER DIRECT OWNERSHIP INTEREST	not provided	Dec 15, 2008
Julita Javier	Individual	Direct owner	5% OR GREATER DIRECT OWNERSHIP INTEREST	not provided	Dec 15, 2008
Pepito Javier	Individual	Direct owner	5% OR GREATER DIRECT OWNERSHIP INTEREST	not provided	Dec 15, 2008
James Rando	Individual	Direct owner	5% OR GREATER DIRECT OWNERSHIP INTEREST	not provided	Dec 15, 2008
Pepito Javier	Individual	Corporate officer / director	CORPORATE DIRECTOR	not provided	Dec 15, 2008
Pelita Sanchez	Individual	Corporate officer / director	CORPORATE DIRECTOR	not provided	Dec 15, 2008
Victor Aquino	Individual	Managing employee	W-2 MANAGING EMPLOYEE	not provided	Apr 16, 2014

Coordinates as published by CMS.

Address: 1250 S. Winchester Boulevard, San Jose, CA 95128
ZIP: 95128
County: Santa Clara County FIPS 06085
State: California
Urban / rural (CMS): Urban

Within ~25 km

Nearby nursing homes

Facility	Distance	Beds	Last inspection	Citations (window)	Fines
Creekside Post-Acute 3580 Payne Avenue, San Jose, CA 95117 CCN 0558842 state class AA/A	0.9 km	130	Jul 24, 2026	791 harm	$20k
Empress Care Center, LLC 1299 S. Bascom Avenue, San Jose, CA 95128 CCN 056026	1.8 km	67	Apr 28, 2025	68	—
White Blossom Care Center 1990 Fruitdale Avenue, San Jose, CA 95128 CCN 5550684 state class AA/A	2 km	153	May 12, 2026	731 IJ1 harm	$97k
Baywood Post Acute 238 Virginia Avenue, Campbell, CA 95008 CCN 555841	2.4 km	45	Apr 4, 2025	56	—
Courtyard Care Center 340 Northlake Drive, San Jose, CA 95117 CCN 5556351 state class AA/A	2.8 km	76	Aug 20, 2026	761 harm2 open	—
Skyline Healthcare Center - San Jose 2065 Forest Avenue, San Jose, CA 95128 CCN 0553182 state class AA/A	2.8 km	253	Aug 12, 2026	1322 IJ1 harm	$105k
O'connor Hospital D/P SNF 2105 Forest Avenue, San Jose, CA 95128 CCN 5559161 state class AA/A	2.8 km	24	Aug 29, 2025	35	—
Camden Postacute Care, Inc 1331 Camden Avenue, Campbell, CA 95008 CCN 5558382 state class AA/A	3.4 km	60	Jul 29, 2026	74	—

Source	Record	Facts	Evidence	Source release	Retrieved
CMS Provider Information US-CMS	056376	name, address, phone, certification, certified_beds, ownership_type, legal_business_name, chain	Verified	Oct 1, 2026	Nov 7, 2026
CMS Provider Information US-CMS	056376	ratings, staffing, health_survey_score Five-Star ratings and PBJ staffing apply to the CMS-certified universe only.	Verified	Oct 1, 2026	Nov 7, 2026
California CDPH Licensed Facility Listing CA	070000095	state_license, licensed_beds, licensee Linked to the CMS record by exact CCN.	Verified	Oct 16, 2026	Nov 7, 2026

Record-level source links for CCN 056376

First seen by Carefield Nov 7, 2026 · last changed Nov 7, 2026. This record as JSON · Report a correction

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A Grace Sub Acute & Skilled Care

Federal certification

State license

Penalties

State enforcement · California

Owners of record

All disclosed roles

Nearby nursing homes

A Grace Sub Acute & Skilled Care

Federal certification

State license

Penalties

State enforcement · California

Owners of record

All disclosed roles

Nearby nursing homes